Health Plan Weekly

Hidden Figures: Medicare Price Negotiation Post-Mortem Offers Few New Insights

  • Jan 03
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    Jan 03, 2025

    CMS’s description of the maximum fair price determination process for the first 10 drugs in the Medicare negotiation program offered little additional insight into how the agency developed price offers or the manufacturer information and arguments the agency found most persuasive.

    CMS released the multi-document post mortem on the inaugural Medicare negotiation process on Dec. 20, which was more than two months ahead of the March 1 deadline. Negotiated prices were announced in August.

    The agency may have been persuaded to release the report early to help manufacturers participating in the next negotiation cycle better prepare for the process. The next cycle will begin with an announcement of the drugs subject to the process by Feb. 1.

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    • Cathy Kelly

    Cathy is a senior writer with Pink Sheet and has covered U.S. regulation and reimbursement policy for the biopharma industry since 2004, starting with the establishment of the Medicare Part D program. Since then, she has written extensively about developments in all major sectors of the U.S. insurance market (Medicare, Medicaid and commercial plans). She has covered key legislation affecting biopharma, including the Medicare Prescription Drug, Improvement, and Modernization Act which created Part D, health care reform under President Obama, and the Inflation Reduction Act. She has closely followed the increasing influence of pharmacy benefit managers and their use of formulary negotiations and rebates to control pricing. Cathy also has covered developments in health technology assessments and has monitored industry progress on novel drug contracting that reflects value-based pricing.

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